DR WEI BOON KHOR FRCSED, FAMS CONSULTANT CORNEA AND EXTERNAL EYE DISEASE SERVICE SINGAPORE NATIONAL EYE CENTRE I HAVE NO FINANCIAL INTERESTS IN THE SUBJECT.

DR WEI BOON KHOR

FRCSED, FAMSC O N S U LTA N T

C O R N E A A N D E X T E R N A L E Y E D I S E A S E S E RV I C E

SINGAPORE NATIONAL EYE CENTRE

I HAVE NO FINANCIAL INTERESTS IN THE SUBJECT MATTER OF THIS

POSTER

Chinese Medicated Oil as a Cause of Accidental Chemical Injury to

the Cornea : A Case Series

Chinese Medicated Oils

Are a traditional homeopathic therapy common in Singapore and many parts of Asia

These medicated oils are a mixture of essential oils; the composition varies from brand to brand, but common ingredients include Menthol crystals Methyl Salicylate Camphor Eucalyptus / Peppermint / Lavender oils

Chinese Medicated Oils

These oils have a characteristic fragrance and are typically sold in small glass bottles

They are usually applied to the skin for treatment of headaches, minor cuts, insect bites, etc

Examples of Chinese Medicated Oils.

Purpose Methods

This poster presents a case series of 4 patients with chemical injuries to the cornea due to accidental application of Chinese medicated oil to the eye

A retrospective case series of consecutive patients with application of medicated oil to the eye, presenting to a Cornea sub-speciality clinic of a tertiary ophthalmic centre

Initial visual acuity, clinical findings, management, complications and final visual acuity were documented

Patients were also questioned as to the reasons why the medicated oil was placed into the eye.

A Case Series

Results

Four Asian females with a mean age of 76 years old (range 68-85) were included

Each patient had injury to the left eye only All admitted to mistaking the medicated oil for

artificial tears, despite the characteristic glass bottles they are sold in

Presenting vision in the injured eye ranged between 6/36 (20/120) to count fingers (CF) vision

In each case, a total / subtotal epithelial defect was noted with Descemet folds, but with no limbal involvement

Results

Initial therapy in all cases was irrigation, followed by intensive medical therapy with preservative-free topical dexamethasone preservative-free lubricants and gels prophylactic broad-spectrum antibiotics (eg levofloxacin) oral Vitamin C supplementation

In those patients with slow re-epithelisation, a bandage contact lens was applied to aid recovery and minimise pain

Unfortunately, the medicated oil involved was not identified / not documented in all 4 cases

The following slides illustrates two of the patients in this series

Patient 1

70-year old female was referred to the Ophthalmology service following accidental application of medicated oil onto her left eye

Visual acuity on presentation was CF at 1 metreExamination showed a total epithelial defect, Descemet

membrane folds, but no limbal ischaemia. Intraocular pressure was within normal range

Medical therapy was initiated the same dayThe epithelial defect healed after 2 weeks, with central

sub-epithelial haze; visual acuity was 6/36 (20/120)The sub-epithelial haze took another 2 week to resolve;

final best corrected vision was 6/9 (20/30) at the final visit

Slit lamp photographs of the left eye of Patient 1

Patient 4

A 76-year-old female presented to the service with redness and decreased vision in the left eye; this was 3 days after accidental instillation of medicated oil to the left eye for “eye irritation”

Pain was reported to be minimal; vision was 6/60 (20/200)

There was a subtotal epithelial defect with no limbal ischemia

Decreased cornea sensation was also noted

Slit lamp photographs of the left eye of Patient 4

Case 4

After a week of therapy, re-epithelisation remained poor; a bandage contact lens was applied

After a second week of treatment, a dendritic epithelial defect with terminal bulbs was noted; the contact lens was removed and topical dexamethasone was stopped

The presumed herpetic ulcer resolved with the use of topical acyclovir ointment 5x/day for one week

Final visual acuity was 6/7.5 (20/25) with the dendrite leaving a faint sub-epithelial scar

Discussion

Chinese medicated oils can result in significant chemical burns to the corneas, although none of our patients developed limbal ischemia nor cicatricial changes to the conjunctiva

All our patients made a full recovery with medical therapy alone, but required between 2-4 weeks of treatment

All our patients were from an older demographic This may have contributed to them mistaking the oil for artificial tears Admission may be required for those with poor social support Age may have contributed to delayed re-epithelisation, and the need

for prolonged treatmentManufacturers of medicated oils should consider a

prominent label on bottles, in order to warn users not to use these products in the eye

Questions or comments? [email protected]